NPIMap

Individual provider Active NPI

Naomi P. Tetzlaff, MD

  • Family Medicine Physician
  • Cottage Grove, MN
National Provider Identifier
1831168236
Registry record updated Mar 11, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
39879 Issued in MN
Practice address
8611 W Point Douglas Rd S
Cottage Grove, MN 55016-4005
Phone
(651) 458-1884
NPI assigned
Mar 16, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 11, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 39879 MN Primary

Addresses

Primary practice location

8611 W Point Douglas Rd S
Cottage Grove, MN 55016-4005

Mailing address

2925 Chicago Ave
Minneapolis, MN 55407-1321
Phone (612) 262-4813

Other identifiers 1

IdentifierTypeStateIssuer
937317900MedicaidMN

Other names 1

  • Ms. Naomi Nicole Peterson Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address ntetzlaff91769@excellian.direct.allina.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050527000623 MN Practitioner - Family Practice 6608818737 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Mayo Medical School, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Allina Health SystemGroup PAC ID 4587573613, shared by 89 NPIs, 3,844 clinicians

Practice addresses (Care Compare)

440 Elm St E
Annandale, MN 55302-1109
Phone (320) 682-5225

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal or shaving of skin growth1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
39879MNMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Allina Health System Family Medicine CurrentSince Dec 31, 2022 Accepting new patients
Allina Health System CurrentSince Jan 1, 2001 Accepting new patients
Allina Health System Family Medicine Current Accepting new patients
Allina Health System CurrentSince Jan 1, 2001 Accepting new patients
Allina Health System Current Accepting new patients
Allina Health System Family Medicine Past Accepting new patients

Locations

440 Elm St E
Annandale, MN 55302
Phone (320) 682-5225

701 Dellwood St S
Cambridge, MN 55008
Phone (763) 689-7700

8611 W Point Douglas Rd S
Cottage Grove, MN 55016
Phone (651) 458-1884

2925 Chicago Ave
#10957
Minneapolis, MN 55407
Phone (612) 262-8640

9055 Springbrook Dr NW
Minneapolis, MN 55433
Phone (763) 780-9155

2215 Park Ave
Minneapolis, MN 55404
Phone (612) 775-8800

2925 Chicago Ave
Minneapolis, MN 55407
Phone (612) 262-4813

333 Smith Ave N
Saint Paul, MN 55102
Phone (651) 220-8256

4625 Churchill St
Shoreview, MN 55126
Phone (651) 483-3522

Interoperability endpoints

  • Direct secure messaging: ntetzlaff91769@excellian.direct.allina.com

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 38

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 38

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1142467200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615420800000",
    "number": "1831168236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2925 CHICAGO AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554071321",
            "telephone_number": "612-262-4813"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8611 W POINT DOUGLAS RD S",
            "city": "COTTAGE GROVE",
            "state": "MN",
            "postal_code": "550164005",
            "telephone_number": "651-458-1884"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TETZLAFF",
        "first_name": "NAOMI",
        "middle_name": "P.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-16",
        "last_updated": "2021-03-11",
        "certification_date": "2021-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "39879",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "937317900",
            "state": "MN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ntetzlaff91769@excellian.direct.allina.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/PDF/TXT",
            "address_1": "8611 W Point Douglas Rd S",
            "city": "Cottage Grove",
            "state": "MN",
            "country_code": "US",
            "postal_code": "550164005",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "NAOMI",
            "last_name": "PETERSON",
            "middle_name": "NICOLE",
            "prefix": "MS.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Cottage Grove, MN

Sources for this page

Verify at the official NPI Registry.